Not dead yet

At the beginning of the famous Monty Python movie “The Search For the Holy Grail,” there is a funny, if not macabre, scene of a ragged and lurching man pulling a cart through the streets of a plague-ridden village, calling to the villagers: “Bring out your dead, bring out your dead!”

In response, a man leaves a small house with the body of a much older man slung over his shoulder. The older man is protesting, “I don’t want to go in the cart.” The younger man replies, “Oh, don’t be such a baby.”

When the cart puller protests that “He’s not dead yet,” the young man answers, “No, but he will be soon; he’s very ill.” Following some humorous negotiation, they bop the older man on the head and throw him on the cart. The cart puller then proceeds down the street, taking up his cry, “Bring out your dead, bring out your dead!”

While obviously intended to reflect a humorous disregard for life held by English peasantry centuries ago, it sadly serves to illustrate a rather disturbing and modern trend of hastening the death of the incapacitated and helpless in modern society. This is most apparent in the ongoing saga of Terri Schiavo, the Florida woman in the throes of a battle that could end her life.

On one side is a court that defined Terri as unconscious and non-responsive, calling her condition a permanent vegetative state. Terri’s husband, Michael Schiavo, then convinced the courts that Terri would not want life-sustaining food and water under these circumstances, resulting in an order to have Terri’s food and water withdrawn.

By a stark and frightening contrast, there are several doctors and rehab experts who assert Terri is brain-damaged but conscious and capable of rehabilitation. What is more, her parents strongly disagree with the decision to starve and dehydrate Terri to death. So they appealed to Gov. Jeb Bush who with the help of the Florida legislature quickly passed a law to have Terri’s tube-supplied food and water reinstated.

So which is it? Is Terri permanently unconscious and non-responsive with only a beating heart and working lungs, or is she merely brain damaged, conscious and capable of rehabilitation? These conditions seem too diametrically opposed to be a matter of debate. Yet they are. No doubt contributing to the confusion is the rather loose use of medical terms such as irreversible coma, coma-like condition and permanent vegetative state.

For the sake of clarity, a coma is defined as a condition of depressed cerebral activity. It can occur for an indeterminate amount of time. That means there is a possibility of waking. A permanent vegetative state, or pvs, is an irreversible condition in which higher brain function is lost but brain stem activity, including heart and lung function, remains intact. No one in a pvs wakes up!

If Terri Schiavo is in a pvs, some would argue she is already dead. Others like her husband argue she is alive but would not want to live under these conditions. Moreover, he argues keeping her alive is a violation of her right to privacy and right to refuse medical treatment. On the other hand, if Terri is only brain-damaged but conscious and capable of rehabilitation, then withdrawing her food and water is the murder of an incapacitated and helpless individual.

In either case, society seems all too willing to view the case through a distorted “right to die” prism that encourages the head-bonking necessary to throw Terri Schiavo and others like her on the cart of death. So how does one avoid a bonk on the head or a court-entrenched Schiavo-like battle? Write an Advance Medical Directive.

Experts estimate that fewer than 12 percent of adult Americans have one. These forms let you give specific instructions about any aspect of your health care. They generally have four parts that include withholding, or withdrawal of treatment to keep you alive; pain relief; organ donation; and designation of a physician.

In writing an advanced directive, special attention should obviously be given to the various states of unconsciousness, including a coma and a pvs. As evidenced by the Schiavo case, misdiagnosis does occur.

To decide Terri’s condition for yourself and whether a pro-death bias exists in this case and its outcome, view the videos of Terri tracking a balloon or responding to music and her mother at http://www.terrisfight.org.